Wednesday, July 8, 2009

Road Rash Care

Some tips from Helen Iams, MD, should you have a close encounter with pavement:

Don't Be Rash

By Alan Coté

Sooner or later, all cyclists hit the deck, and the almost inevitable result is road rash. Such abrasions usually require only basic care. Wyomingbased Helen Iams, MD, developed a preferred course of treatment as the staff doctor for the Jelly Belly Pro cycling team. She has also served as the medical director for races such as the U. S. Pro Criterium Championships. "Pro riders give me lots of practice with road rash," says Iams. Here's her prescription for fast healing.

FIRST RESPONSE Before sizing up skin loss, evaluate the injured person's whole self. "I've had riders come into the medical tent with cracked-open helmets, but no idea they had hit their head," says Iams. If you're with a group and the injured rider has slowed or slurred speech, call for medical assistance. Solo? That's a good reason to carry a cell phone. Got a gash that's more than a scrape? Iams's rule: If you can't stop the bleeding by applying pressure for 15 minutes, you need stitches.

FIELD DRESSING Post crash, a cyclist often sprays the wound with his water bottle. "That's not a bad idea to get rid of dirt," Iams says. "But the bacteria on the bottle valve are bad." Antiseptic wipes are Iams's top pick. Or try her secret remedy: Preparation H wipes, which include witch hazel and a little soap.

GET THE GRIT OUT Wash the rash as soon as you get home. To clean it well, says Iams, you should begin with painkillers. She starts by blanketing the wound with 4x4-inch gauze pads saturated with nonprescription Band-Aid antiseptic wash. "The antiseptic wash has lidocaine, a local anesthetic," she says. "I let the gauze soak in for a few minutes until the nerves are numbed." (Iams cautions that large quantities of lidocaine can cause an irregular heartbeat, so avoid overuse.) Then Iams gently wipes the grime from the scrape, using soap and water. "You need to get all the grit, bits of asphalt—everything," she says. "That stuff can have bacteria behind it." Stay clear of iodine, alcohol and hydrogen peroxide. "Those damage skin cells," she says. "The less damage there is to the skin, the faster it heals." For stubborn, sticky contaminants like road tar, Iams recommends baby oil or Dawn dish soap. "Either will dissolve the tar, and you won't need to scrub."

LET THE HEALING BEGIN After you wash the area, cover the abrasion to keep it clean and moist. Iams applies Bacitracin, which kills bacteria and prevents the wound from drying or sticking to the bandage. Then she uses generic, nonstick, gauze-type bandages, secured with silk tape. "I use cheap dressings until the oozing slows down, maybe a few days," she says. Then it's time for advanced hydrocolloid bandages like Tegaderm—precious stuff for road-rash victims. "Put them on, and just leave them for a week until they fall off," she says. "They keep bacteria out, but let water come through and evaporate." Iams's other days-after tips: Ice the afflicted area to reduce swelling, and use acetaminophen for pain—not ibuprofen, which thins blood and can increase bruising. If you have any concerns, hotfoot it to your doctor.